On Tuesday, December 4th, members of the Mount Sinai community gathered to learn about a relatively new area of healthcare scholarship: Graphic Medicine. As the latest installment of Levy Library's Mindful Medicine series, "Introduction to Graphic Medicine" was lead by Dr. Grace Farris, Chief of the Division of Hospital Medicine at Mount Sinai West and a bioethicist whose own comics have appeared in MUTHA Magazine and the Annals of Internal Medicine. According the Dr. Farris, this rapidly emerging medium combines narrative medicine with the power of graphics to enhance communication about patient and provider experiences.
Dr. Ian Williams, a pioneer of Graphic Medicine, originally denoted the form as "the intersection between the medium of comics and the discourse of healthcare." Graphic Medicine can be very helpful with system-based learning objectives when designing medical curriculum. On the patient/provider side, this application helps to provide different perspectives throughout the healthcare and medical experiences. Drawing or reading Graphic Medicine content can also be utilized in physician burnout resilience.
One big takeaway of this workshop? If you know how to write, you already know how to draw. You don't need to be the next great artist. Just grab some paper, a pencil and tell your story!
Click here to learn more about Graphic Medicine at Levy Library
Each month Levy Library showcases the achievements of Mount Sinai faculty and researchers by highlighting an article and its altmetrics. Altmetrics are alternative measures of impact that capture non-traditional data like abstract views, article downloads, and social media activity.
This month we highlight Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data. This article was written by a team of researchers including Mount Sinai’s Valentin Fuster (Cardiology), Michael J. Domanski (Cardiology), and Michael E. Farkouh (Cardiology).
CITATION
Lancet, Volume 391, Issue 10124, 10–16 March 2018, Pages 939-948.
BACKGROUND
Numerous randomised trials have compared coronary artery bypass grafting(CABG) with percutaneous coronary intervention (PCI) for patients with coronary artery disease. However, no studies have been powered to detect a difference in mortality between the revascularisation strategies.
METHODS
We did a systematic review up to July 19, 2017, to identify randomised clinical trials comparing CABG with PCI using stents. Eligible studies included patients with multivessel or left main coronary artery disease who did not present with acute myocardial infarction, did PCI with stents (bare-metal or drug-eluting), and had more than 1 year of follow-up for all-cause mortality. In a collaborative, pooled analysis of individual patient data from the identified trials, we estimated all-cause mortality up to 5 years using Kaplan-Meier analyses and compared PCI with CABG using a random-effects Cox proportional-hazards model stratified by trial. Consistency of treatment effect was explored in subgroup analyses, with subgroups defined according to baseline clinical and anatomical characteristics.
FINDINGS
We included 11 randomised trials involving 11 518 patients selected by heart teams who were assigned to PCI (n=5753) or to CABG (n=5765). 976 patients died over a mean follow-up of 3·8 years (SD 1·4). Mean Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score was 26·0 (SD 9·5), with 1798 (22·1%) of 8138 patients having a SYNTAX score of 33 or higher. 5 year all-cause mortality was 11·2% after PCI and 9·2% after CABG (hazard ratio [HR] 1·20, 95% CI 1·06–1·37; p=0·0038). 5 year all-cause mortality was significantly different between the interventions in patients with multivessel disease (11·5% after PCI vs 8·9% after CABG; HR 1·28, 95% CI 1·09–1·49; p=0·0019), including in those with diabetes (15·5% vs 10·0%; 1·48, 1·19–1·84; p=0·0004), but not in those without diabetes (8·7% vs 8·0%; 1·08, 0·86–1·36; p=0·49). SYNTAX score had a significant effect on the difference between the interventions in multivessel disease. 5 year all-cause mortality was similar between the interventions in patients with left main disease (10·7% after PCI vs 10·5% after CABG; 1·07, 0·87–1·33; p=0·52), regardless of diabetes status and SYNTAX score.
INTERPRETATION
CABG had a mortality benefit over PCI in patients with multivessel disease, particularly those with diabetes and higher coronary complexity. No benefit for CABG over PCI was seen in patients with left main disease. Longer follow-up is needed to better define mortality differences between the revascularisation strategies.
Find the full text here
See Dr. Valentin Fuster's PLUM profile here
See Dr. Michael J. Domanski's PLUM profile here
See Dr. Michael E. Farkouh's PLUM profile here